4666 Penkwe Way - Inspection FormCity oL to p
Residential Sanitary Sewer Service
Compliance Inspection
Date ! / / / i`( Time • b pm
Name r' 1 z . J� � . Disk ##
PID Number
House Number o "?.':'r`-: Street Name
Alternative Mailing Address
Transition / iz
4" to 6" Transition:
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
White Copy: Property Owner
Phone ~
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer•
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Yellow Copy: City of Eagan
Record Number.
j 1
/
Length of Service: r —r-
Time
Inspector Signature
Obstruction
Unable to push past
feet.
• ? am
• ._... ' o Pm
9 Entered S.L.at
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
° i
Final Cleanout:l 4,..-- . `� �
[.: v: -. -- --•, f 1s r
Pink Copy: SEH
Total
Notes
Number
Discharged
Correctly
Incorrectly
Unknown
Sump pumps
Foundation drains
f `
/ 1`
Roof drains
Lr'
City oL to p
Residential Sanitary Sewer Service
Compliance Inspection
Date ! / / / i`( Time • b pm
Name r' 1 z . J� � . Disk ##
PID Number
House Number o "?.':'r`-: Street Name
Alternative Mailing Address
Transition / iz
4" to 6" Transition:
Owner /Occupant Signature
Compliance
O No foundation drain connection
O No roof drain connection
O Sump pit not connected to
sanitary sewer
O Sump pump properly piped
O No sump pump
White Copy: Property Owner
Phone ~
For information call 651.470.2788
Non - Compliance
O Clear water connections to
sanitary sewer•
O Service lateral defects
O Defective manholes
O Sump pump connected to sanitary
sewer
O Flexible sump pump piping
Service Lateral Inspection Findings Number of stacks
Yellow Copy: City of Eagan
Record Number.
j 1
/
Length of Service: r —r-
Time
Inspector Signature
Obstruction
Unable to push past
feet.
• ? am
• ._... ' o Pm
9 Entered S.L.at
No Access
O No one in
O Access to service
lateral needed
O Inspection
refused
Roots
Poor Pipe Joints
Mineral Deposits
Sag /Pipe Deflection
Damaged Pipe
° i
Final Cleanout:l 4,..-- . `� �
[.: v: -. -- --•, f 1s r
Pink Copy: SEH